Early and mid-term outcomes of minimally invasive mitral valve repair via right mini-thoracotomy: 5-year experience with 129 consecutive patients

• Published in: General thoracic and cardiovascular surgery 2021-08, Vol.69 (8), p.1174-1184
• Main Authors: Nakayama, Taisuke, Nakamura, Yoshitsugu, Yasumoto, Yuto, Yoshiyama, Daiki, Kuroda, Miho, Nishijima, Shuhei, Ito, Yujiro, Tsuruta, Ryo, Hori, Takaki
• Format: Article
• Language: English
• Subjects: Calcification; Cardiac Surgery; Cardiology; Cardiovascular disease; Coronary vessels; Hospitals; Magnetic resonance imaging; Medicine; Medicine & Public Health; Mortality; Original; Original Article; Ostomy; Patients; Potassium; Surgical Oncology; Thoracic Surgery; Thrombosis; Ventilation
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-020-01573-2

Objectives This study analyzed the experience of a single institution with minimally invasive mitral valve repair (MIMVr) via a right mini-thoracotomy (RT), including short and mid-term morbidity and mortality as surgical outcomes, and rates of reoperation. Late follow-up findings regarding mitral regurgitation (MR) were also assessed. Methods Between January 2014 and January 2020, a total of 141 consecutive patients underwent MIMVr for mitral regurgitation at our institution via an RT, with late follow-up results (median 35 ± 15 months) available for 129 (91.4%). Findings regarding surgical approach, complications, reoperations, and late survival were examined. Late echocardiographic results showing recurrence of MR after mitral repair were also noted. Survival, freedom from reoperation, and recurrent MR (grade > 2) were evaluated by Kaplan–Meier analysis. Results Mean age was 63.9 ± 14.3 years, mean ejection fraction was 66.9 ± 10.4%, and 2 patients (1.6%) underwent a reoperation. Concomitant procedures included atrial fibrillation ablation (18%), tricuspid valve surgery (16%). None (0%) experienced intraoperative conversion to sternotomy. A learning curve was observed as the number of cases increased. Overall in-hospital mortality and stroke incidence were both 0%. Freedom from recurrent MR (grade > 2) at 1, 3, and 5 years was 99.2, 94.9, and 94.9%, respectively, while freedom from reoperation at 1, 3, and 5 years after mitral valve repair was 98.4, 98.4, and 98.4%, respectively. Conclusions Early and mid-term results of MIMVr were satisfactory, with low rates of perioperative morbidity and recurrent MR, as well as reoperation and death. Furthermore, the protocols for patient selection and surgical approach were considered to be appropriate.